1. Prime Minister’s Challenge Fund Application by Coventry and Rugby GPs January 2015

2. Walk in Urgent GP streamRoutine stream A&E Weekend or 8-10 booking Three schemes: Scheme 1: Extended hours hub Patients PMCF SchemesExisting servicesPatient flow GP practicesNHS 111 4-8pm booking Extended hours hub (Single point) Face to faceTel GP practices (e.g. For referral) No further service Shared Patient record Central Coventry City hub Appointment only (4-8 weekdays / weekend mornings) Face to face, telephone, email and video conference offered Routine appointments (improving screening) Urgent appointments (reducing A&E pressure) Shared records

3. Acute frailty pathway A&E Patients PMCF SchemesExisting servicesPatient flow Integrated Neighbour hood teams Discharge Care plan Existing services under GP Acute nursing team Gerontology Primary care frailty team 24-48hr health and social and carer assessment Acute frailty unit Care navigator Prevent and educate Frailty Scale Shared Patient record Frailty stream Three schemes: Scheme 2: Primary Care led frailty team Edmonton Frailty Multi-skilled team (incl. Social and voluntary care) Hospital assessments (speed up discharge) Home assessments (keep people safe) Care co-ordinator / navigator to establish services against care plan

4. A&E Patients PMCF SchemesExisting servicesPatient flow GP consultation in A&E Education (Attendance reduction) GP in A&E GP practice / Scheme 1Scheme 2 FrailtyHomeOther community Acute referral Direct appointments / referral bookings Patient data analysis Streaming by A&E nurses Active case finding by GPs Shared Patient record A&E Stream (80% plus or 400 per day) e.g. ED majors GP stream up to c. 20% (100/day) Three schemes: Scheme 3: GP in A&E Formal defined protocols, training and systematic approach GP Led with ANP support (1:2 ratio) c. 1 in 5 people seen (c. 38,500/yr) Expedited assessment and referral / discharge Links to other two schemes

5. Key benefits / outcomes Strong focus on reducing pressure in urgent care pathways SchemeBenefits / outputs 1: Extended Hours Additional c. 25,000 appointments (TBA) Reduction in A&E attendance Improved patient experience 2: Frailty c. 2,500 cases with enhanced review and care co-ordination Faster return to home Reduced DToC Reduced return to treatment Reduced A&E attendance 3: GP in A&E c. 38,500 additional ‘appointments’ Improved 4hr wait Improved patient experience Reduced attendance Reduced admissions

6. Implementation An agile, phased approach to implementation Q4 ‘14/’15FY ‘15/’16FY ‘16/’17 Federation preparation PMCF Funding starts PMCF Funding ends Design, Project management and evaluations Extended running Scheme 1: Extended hours Scheme 2: Frailty team Scheme 3: GP in A&E Full operationPhase inDesign Service starts Full design realised Decision to extend Commission Stop / Go Extended running Full operationPhase inDesign Service starts Full design realised Decision to extend Commission Stop / Go Extended runningFull operationPhase inDesign Service starts Full design realised Commission Stop / Go

7. Funding: Current view of PMCF request (excluding additional funding) £000’s Scheme 1: Extended Hours813 Scheme 2: Frailty1,215 Scheme 3: GP in A&E873 Governance and PMO318 Benefits realisation150 Design and Analytics180 TOTAL3,549